Orthorexia Nervosa (ON)

What is orthorexia?

Orthorexia nervosa (ON) is a relatively new eating disorder that remains much a mystery to physicians and psychotherapists. Although it shares many similarities to anorexia nervosa, it focuses on an obsessive urge to be “healthy” rather than to be thin.

Although eating healthy is highly appealing to many in a world in which junk food is available at every turn and obesity levels are at an all time high, in some instances the desire to eat “clean” can become extreme. When an individual’s urge to eat healthily develops into extreme food restrictions, obsessive thoughts, anxiety, fear of food and malnourishment, they are likely suffering from orthorexia.

Overview of orthorexia nervosa

Orthorexia (ON) is an eating disorder which causes obsessive behavior around food. Individuals who suffer from the condition become preoccupied with the need to consume only foods which they deem to be healthy, to the point that they will adopt heavily restrictive diets which could lead to them becoming malnourished.

Orthorexia nervosa is not yet recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM), perhaps since it is a relatively modern condition, having only first been named in 1996 by American doctor Stephen Bratman. “Ortho” means “right”, “orexia”, means hunger and “nervosa” means “fixation” or “obsession”. Dr. Bratman coined the term as an analogy to anorexia nervosa, a condition which causes people to heavily restrict their food intake until they become dangerously underweight.

Individuals with orthorexia nervosa do not necessarily aim to starve themselves or lose weight as with anorexia, but they do become obsessed with healthy eating to the point that they may not get the adequate nutrition they need and could lose lots of weight and become seriously ill as a result. They also typically struggle with feelings of shame, guilt and self-esteem if they break from their strict dietary plans, and struggle to eat in public or socially due to the restrictions they place on their diets. Many of these feelings and behaviors share similarities with those of anorexia.

Initially, Dr. Bratman coined the term orthorexia (ON) to help a handful of his patients who were struggling with obsessive behavior around healthy eating. He hoped that by defining their behavior with a named disorder, he could help them to focus on a “cure”. He didn’t initially deem the term a serious diagnosis, but after writing about it in Yoga Journal in 1997, it was quickly picked up by other magazines and became a well-known phrase. This demonstrated to Dr. Bratman that the diagnosis resonated with large numbers of people and that further investigation needed to be done to compile a list of common symptoms and establish the prevalence of the condition.

It is still not quite clear how many people suffer from orthorexia in the US, although anecdotal evidence suggests it could be relatively common, particularly in young people. Carol Cottrill, a certified nutritionist, estimates that the condition currently affects one in 10 women and one in 20 men in the US.

Orthorexia symptoms

Despite not being recognized in the DSM, orthorexia (ON) does have a series of clearly defined symptoms which have been outlined by Dr. Stephen Bratman in his proposed diagnostic criteria.

Individuals with orthorexia focus obsessively on “healthy” eating. Their obsession may be based on a specific diet or set of beliefs about certain food types, but there is no individual dietary theory that all people with subscribe to. Sufferers feel emotional distress when dealing with food choices which are not in line with their “healthy” diet or which they perceive as “unhealthy”.

Weight loss may be caused by orthorexia, although this is typically not the primary goal of sufferers. However, many will see their weight as one of many aspects of their ideal health status.

People with orthorexia will show signs of compulsive behavior in regards to their dietary practices. This could involve extreme restriction or excessive consumption of certain food types and use of food supplements. Exercise is often closely tied in, with sufferers looking to physical performance or body types as an indicator of health.

Individuals might have exaggerated fears of disease and of feeling physically unwell. They may feel impure when faced with “unhealthy” foods, and frequently feel anxious, guilty or shameful if their diet is not as “clean” as they feel it should be. Usually, the self-imposed restrictions become more and more dramatic and severe over time and can result in entire food groups becoming eliminated from their diet.

In many instances, individuals will turn to partial fasts in an attempt to “detox” or purify their bodies, and such fasts will become more and more frequent and severe. Subsequently, sufferers will lose weight without necessarily trying to do so.

The compulsive behavior around food and health can then cause a series of secondary problems. Sufferers may become malnourished or dangerously underweight due to their restricted diet. Their social lives, academic ambitions and careers may be affected due to their obsessive behavior or distress surrounding food. Plus, it’s possible that they may suffer with body image and identity since much of their self-worth is tied intrinsically to their “healthy” eating behavior.

Subtle signs of orthorexia also include:

Obsessive focus on planning, purchasing and preparing foods

Deeming food as a source of health rather than source of pleasure

Feeling disgusted or distressed around prohibited “unhealthy” foods

Persistent belief in diets or foods which can prevent or cure disease, even despite conflicting evidence or evidence of malnutrition

Distorted body image focused on sense of “impurity” rather than weight or body type

Moral judgment of others according to their dietary choices

Becoming distant from friends and family who do not share the same views about food

Depression, mood swings and anxiety

Fear when eating away from home due to inability to comply with diet

It’s important to note that not all attempts to eat healthily or enjoy a healthy lifestyle are deemed instances of orthorexia. Making conscious choices to consume foods which nourish the body and help to maintain good health is not usually detrimental to a person’s well-being, nor is following a particular type of diet, such as veganism or vegetarianism.

It is only when attempts to eat healthily become obsessive and detrimental to an individual’s physical and mental well-being that one might be deemed orthorexic.

Orthorexia causes

There has not been enough research conducted into orthorexia (ON) to fully understand what causes the condition. However, there are several theories about why individuals may develop it.

Typically, the condition develops from relatively minor dietary restrictions, which an individual might adopt in an attempt to improve their health. This could be because they are suffering from a particular illness or chronic medical condition, or simply because they feel generally unwell.

In some instances, orthorexia develops out of a need to create an identity. By adopting a particular diet, one might feel as though they are part of a community or that they have a sense of purpose. For some, adopting extreme diets is linked with a need for spirituality and they may tie morality in closely with dietary choices.

Some orthorexia sufferers strive to improve their self-esteem with dietary restrictions and feel that eating “healthy” foods will increase their self-worth. For others, dietary restrictions are borne out of a desire to have control due over emotional turmoil that they may be experiencing in other parts of their life. Similarly, adopting a particular diet may serve as a method to escape or distract from certain fears, stresses or anxieties.

Orthorexia treatment

The primary treatment for orthorexia (ON) is psychotherapy. Patients might work with counselors or therapists to identify the underlying causes for their orthorexia and work to resolve them. Cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT) and behavioral modification therapy are all examples of psychotherapies that may be used to help break harmful orthorexic habits and thought patterns and adopt healthier coping mechanisms.

In some instances, doctors may prescribe medications to aid in recovery from orthorexia, but only in instances where the condition appears to have developed from an underlying mental health issue, or has caused a concurrent mental health issue. An individual who appears to have developed orthorexic behavior as a result of a desire to regain control over feelings of anxiety, for example, might be treated with anti-anxiety medication. However, there is no clear evidence that a particular type of medication is suitable for treating all cases of orthorexia.

Individuals who have been diagnosed with orthorexia may have become physically unwell as a result of the condition. In these instances, doctors may refer them to nutritionists who will formulate a balanced diet to restore their physical health and help them to reach a healthy weight. Working with a nutritionist can also help patients to develop a more accurate understanding of what it means to eat healthfully.

If orthorexia has compromised an individual’s physical health, they may require additional treatments. For example, dangerously malnourished patients may need to be hospitalized in order that nasogastric tube feeding or intravenous infusion can be performed. In other situations, vitamins and mineral supplements may be prescribed to help restore physical health while the patient undergoes therapy and slowly adopts a more balanced, nutritionally sound diet.

Orthorexia prevention

Individuals who are striving to improve their overall diet and lifestyle in order to optimize their health should firstly understand the symptoms of orthorexia (ON) in order to recognize signs that their behavior could become extreme. In particular, they should be careful that their dietary habits do not cause them undue anxiety or fear, as these are clear warning signs that their relationship with food has become obsessive. Rapid weight loss is also an indicator that dietary choices have become too restrictive.

It is usually wise to consult a physician before making any dramatic changes to diet and lifestyle. A doctor will be able to advise which “healthy eating” choices may be helpful, and which may be harmful. They will also be able to perform regular blood tests to monitor nutrition levels and discover deficiencies which may have come about as a result of dietary changes.

When considering adopting a new diet regimen, it might be helpful to establish the primary motivator behind the decision. Those who are striving to take control of their diet as a result of feeling out of control in other aspects of their life could be at an increased risk of orthorexia.

Similarly, individuals with a history of low self-esteem, poor body image, anxiety and obsessive compulsive disorder could be more at risk of developing extreme behaviors and unhealthy thought patterns surrounding food. In these instances, it is particularly important to seek advice from a physician or psychotherapist.

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